{% load comp_filters %}
    <form id='form-addservice' action="">
      <input type='hidden' name='icon' value='icon'/> 
      <p class='regi'>
        <label for='name'>Shop Name:</label>
        <span class='input-fine'>
          &#9746
        </span>
        <input type='textfield' name='name' value='{{REQUEST.name}}'/>
      </p>
      <p class='regi'>
        <label for"type">Service Type:</label>
        {% select %}
        {"style":"width: 348px;",
         "fields":["Brothel","Escort","Massage"],
         "default":"Brothel",
         "name":"type"}
        {% endselect %}
      </p>
      <p class='regi'>
        <label for"price">Price:</label>
        {% select %}
        {"name":"price",
        "style":"width: 348px;",
        "fields":["10-20","20-40","40-160"],
        "default":"10-20"}
        {% endselect %}
      </p>
      <p class='regi'>
        <label for='phone'>Phone:</label>
        <span class='input-fine'>
          &#9746
        </span>
        <input type='textfield' name='phone' value='{{REQUEST.phone}}'/>
      </p>
      <p class='regi'>
        <label for="address">Address:</label>
        <span class='input-fine'>
          &#9746
        </span>
        <input type='textfield' name='address' id='address-input' value='{{REQUEST.phone}}'/>
      </p>
      <p class='regi'>
        <label for="email">Email:</label>
        <span class='input-fine'>
          &#9746
        </span>
        <input type='textfield' name='email' value='{{REQUEST.email}}'/> 
      </p>
      <p class='regi'>
        <label for="description">Description:</label>
        <span class='input-fine'>
          &#9746
        </span>
        <textarea name='description' value='{{REQUEST.phone}}'></textarea>
      </p>
      <div id='days'>
        <a>Working Days:</a></br>
        <input type = checkbox name='Mon' value = 'Mon'>Mon.</input>
        <input type = checkbox name='Tue' value = 'Tue'>Tue.</input>
        <input type = checkbox name='Wed' value = 'Wed'>Wed.</input>
        <input type = checkbox name='Thu' value = 'Thu'>Thu.</input>
        <input type = checkbox name='Fri' value = 'Fri'>Fri.</input>
        <input type = checkbox name='Sat' value = 'Sat'>Sat.</input>
        <input type = checkbox name='Sun' value = 'Sun'>Sun.</input>
      </div>
      <p id='grade'>
        <input type='textfield' name='grade' value='1'/>
      </p>
      <p id='privilege'>
        <input type='textfield' name='privilege' value='normal'/>
      </p>
      <p id='local'>
        <input type='textfield' name='local' value='normal'/>
      </p>
      <p>
        <span class='commit' style='margin-right:25px;' onclick='zoyoe.ui.SubmitForm();'>Create & Publish</span>
        <span class='cancel' onclick='zoyoe.ui.HideDialog();'>Back</span>
      </p>
    <br style="clear:both">
    </form>
